In patients with unstable angina, argatroban inhibits clotting (aPTT prolongation) and thrombin activity toward fibrinogen (fibrinopeptide A decrease), but in vivo thrombin (thrombin-antithrombin III complex) formation is not suppressed. However, cessation of infusion is associated with rebound thrombin (thrombin-antithrombin III complex) generation and with an early dose-related recurrence of unstable angina. Although the mechanism of this clinical and biochemical rebound phenomenon remains to be determined, its implication for the clinical use of specific thrombin inhibitors in the management of ischemic coronary syndromes may be significant.
Intracardiac leiomyomatosis may be defined as the rare intravenous extension of a histologically benign smooth muscle tumor of extracardiac origin to the right heart. We are reporting an unusual case of an intracardiac leiomyoma with interesting features visualized by transesophageal echocardiography.
CASE REPORTA 44-year-old white woman whose medical history was remarkable only for hypothyroidism was referred for the evaluation of anasarca with associated hepatic and renal dysfunction. Initial evaluation at this institution revealed a morbidly obese woman who weighed approximately 370 pounds and appeared chronically ill. Pertinent findings included a jugular venous pressure of 14 cm H20, bibasilar rales, distant heart sounds including an S4, and no murmurs. There was shifting dullness of the abdomen. Pplvic and rectal examinations revealed no masses. There was 2+ pitting edema of the lower extremities. Chest xray showed a free-flowing left pleural effusion, and the electrocardiogram revealed sinus rhythm, right axis deviation, and low voltage.The initial echocardiogram was performed with the use of a transthoracic approach and standard phased array real-time equipment with a 2.5-MHz transducer. The examination was suboptimal because of the patient's obesity. The study, although limited, revealed normal left ventricular and left atrial size and function. Paradoxic septal motion was noted, however, the cause was unclear.The right heart could not be imaged adequately; our visualization of it was limited to a small portion of the right ventricle, seen in the parasternal long axis view (Fig. 1). Additional findings included an unusual continuous-wave doppler signal that went away from the transducer held in the apical position. Its duration varied between early, late, and holosystolic. We believed that this represented moderate to severe tricuspid regurgitation. A small circumferential pericardial effusion was also observed.Prospective interpretation indicated that these findings were consistent with right ventricular volume overload. Among the differential diagnoses given were severe tricuspid regurgitation, atrial septal defect, primary pulmonary hypertension, and right heart failure.
Ectopic odontomas are a rare disease process and need to be in the differential of the Otolaryngologist and Radiologist. Previous reports reveal the most common location to be the maxilla. We present a rare case of odontoma involving a turbinate causing nasal obstruction and foul-smelling rhinorrhea. Surgical excision is the treatment of choice with an endoscopic approach, if feasible.
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